In contrast to purely physical ailments, like a scrap of the knee or a broken arm, depression can manifest itself in people in a variety of different ways. One person dealing with depression may lose their appetite completely, while another spends all their time snacking on junk food. Due to depression’s many forms, it’s often been said that there is no one effective depression treatment that will work for everyone. It’s a complicated illness that requires individualized attention.
However, that may just change soon. A new approach to depression treatment developed by Stanford Medicine has yielded almost unbelievably positive results in a small initial study. An incredible 90% of treated patients reported significant reductions in their depressive thoughts and symptoms.
The treatment, a form of magnetic brain stimulation, isn’t entirely new. Transcranial magnetic stimulation has already been approved by the FDA as a treatment for depression, but the team at Stanford has updated and improved on the treatment by ramping up the number of magnetic pulses, speeding up the treatment schedule, and focusing more closely on specific brain areas.
A larger research project is already underway to validate the ultra promising results from this first study. The research team is very optimistic that their newly designed treatment, nicknamed SAINT (Stanford Accelerated Intelligent Neuromodulation Therapy), will prove to be an invaluable treatment option for depression patients who haven’t seen relief from more traditional options like medication or therapy.
“There’s never been a therapy for treatment-resistant depression that’s broken 55% remission rates in open-label testing,” comments senior study author Nolan Williams, MD, assistant professor of psychiatry and behavioral sciences, in a press release. “Electroconvulsive therapy is thought to be the gold standard, but it has only an average 48% remission rate in treatment-resistant depression. No one expected these kinds of results.”
The thought of having one’s brain be “magnetically stimulated” may sound unpleasant, but study participants didn’t report any pain during the treatments, only some fatigue shortly afterward and mild discomfort.
A total of 21 participants took part in this study, and each one was classified as “severely depressed” according to several standard diagnostic tests. By the end of the treatment schedule, 19 were classified as “non-depressed.” Before treatment began all 21 patients reported having periodic suicidal thoughts, but not a single one had thoughts of suicide after receiving the treatment. All participants had been unsuccessful in treating their depression using traditional methods.
One of the study’s participants, 60-year old Deirdre Lehman, gave a first-hand account of her struggle with depression and the relief she felt after receiving the SAINT treatment. Lehman had struggled with bipolar disorder all her life but says she woke up one morning in the summer of 2018 feeling particularly down.
“There was a constant chattering in my brain: It was my own voice talking about depression, agony, hopelessness,” she articulates. “I told my husband, ‘I’m going down and I’m heading toward suicide.’ There seemed to be no other option.”
After being referred to the SAINT program by her psychiatrist, the research team worked with Lehman to pinpoint the exact area in her brain that would benefit the most from magnetic stimulation. The ensuing results changed her life.
“By the third round, the chatter started to ease,” she says. “By lunch, I could look my husband in the eye. With each session, the chatter got less and less until it was completely quiet. That was the most peace there’s been in my brain since I was 16 and started down the path to bipolar disorder.”
So, how does all this work and how did the team at Stanford devise their new treatment plan? During transcranial magnetic stimulation, generally speaking, a magnetic coil is placed on patients’ scalps that emits magnetic waves intended to “excite” brain regions thought to play a role in depression. Earlier versions of this treatment consisted of once-daily sessions for about six weeks. Unfortunately, only about half of patients who receive this version of the treatment see their depression improve, and only a third report depression remission. Not exactly super effective.
With these middling results in mind, Stanford researchers theorized that some adjustments could increase the treatment’s effectiveness. First off, they used a much higher magnetic dose (1,800 pulses per session in comparison to just 600) and ramped up the speed of the treatment schedule. During the SAINT study, participants underwent 10 sessions each day consisting of 10-minute intervals. After each day, further treatments were tailored to how an individual patient was feeling. For example, Lehman felt better after just one day, but other participants didn’t feel relief until undergoing treatment for five days. On average, it took about three days of SAINT treatment for a patient to feel their depression alleviate.
Beyond just increasing the frequency and dosage, researchers also targeted more exact locations within patients’ brains. Earlier versions of transcranial magnetic stimulation focused broadly on the dorsolateral prefrontal cortex, a brain area responsible for memory selection and inhibition. The SAINT approach utilizes brain imaging technology to pinpoint specific subregions of the dorsolateral prefrontal cortex specifically associated with depression.
Just to be 100% sure of SAINT’s safety, the research team even tested participants’ cognitive skills before and after treatment sessions. Not only were there no negative side effects, but patients’ mental quickness and problem-solving skills also showed improvement.
A follow-up survey one month after the treatment ended showed that 60% of patients were still depression-free.
Circling back to Deirdre Lehman’s personal story for a moment; today she says she’s happier and calmer than ever before.
“I used to cry over the slightest thing,” she describes. “But when bad things happen now, I’m just resilient and stable. I’m in a much more peaceful state of mind, able to enjoy the positive things in life with the energy to get things done.”
The full study can be found here, published in the American Journal of Psychiatry.